共查询到20条相似文献，搜索用时 46 毫秒
1.
Majed Hababeh Amjad Matooq Abdalla Odattalla Asa&#x;ad Na&#x;jeh Hanan diab Imad Burbara Amjad khoury Zaki Saleh Ayoub Ayoub Mohammad Salameh Mohammad Hadi Saleh Ali Khader Akihiro Seita Patricia Di Caccamo Lilia Biscaglia Mari Antonietta Arrica Cristiana Zerosi Guglielmo Campus 《Lancet》2019
Background
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) School Health Programme provides preventive oral health services to school students through regular dental screening of new entrants and fourth and seventh grade students, in addition to the health education activities and treatment of decayed teeth provided by dental surgeons in health centres and by mobile dental teams. The main focus of UNRWA oral health services continues to be prevention rather than treatment. The objective of this follow-up survey was to calculate decayed, missing, and filled teeth (DMFT), and decayed, missing, and filled surfaces (DMFS) indices among seventh grade UNRWA schoolchildren in all five areas in which UNRWA operates (Gaza, Jordan, Lebanon, Syria, and West Bank), and to compare the results of this survey globally, locally and with a previous survey conducted in 2010 and 2011.Methods
A cross-sectional survey was conducted by calibrated examiners between March, 2016, and May, 2016. Two-stage sampling was used, with schools selected during the first stage and classes selected in the second stage. The sample size was calculated based on the number of students registered in each area. The confidence level was 95%, power 80%, and precision 5%. A total of 1550 children participated (100% response rate), 383 in Jordan, 390 in Lebanon, 340 in West Bank, and 437 in Gaza. All participants provided verbal informed consent. Data were analysed using Epi Info 7. Multiple logistic regression was used to analyse caries experience, prevalence of caries, and the most relevant behavioural and sociodemographic indicators. A p value of less than 0·05 was considered statistically significant.Findings
The prevalence of dental caries among examined children was 72·8% (1129 of 1550; 95% CI 70·5–75·0); the highest prevalence was in the West Bank (79·7%; 271 of 340) and lowest was in Jordan (68·4%; 262 of 383). The prevalence of untreated decayed surfaces was 69·4% (1076 of 1550; 95% CI 67·0–71·7); the highest prevalence was in the West Bank (76·8%; 261 of 340) and lowest was in Jordan (64·0%; 245 of 383). The percentage of children with one or more sealed permanent teeth was 9·8% (8·4–11·4), compared with 6·8% in 2011, and with wide variation between areas; the highest prevalence was in Lebanon (31.5%), while in Gaza and the West Bank the prevalence was less than 2·0%. The percentage of children who did not use a toothbrush and toothpaste was 19·1%, compared with 22·0% in 2011. The percentage of children who cleaned their teeth after every meal was 59·3% (919 of 1550), compared with 31·6% in 2011. Overall, 18·3% (284 of 1550) of children had never attended a dentist, and 83·1% (1289 of 1550) had experienced toothache in the past. In the total sample, 66·0% (1022 of 1550) of children were used to drinking soft drinks during meals. This habit was less frequent in Gaza (37·5%; 164 of 437) than in Jordan (71·1%; 272 of 383), the West Bank (75·0%; 255 of 340), and Lebanon (75·0%; 292 of 390).Interpretation
The prevalence of dental caries remains very high in Palestinian refugee school children, of whom only 27·2% are free of caries. The high percentage of untreated dental caries and the low percentage of sealed teeth call for increased efforts, refinement, and completion of the preventive strategies of the UNRWA. The main behavioural factors relating to the prevalence and severity of caries were frequency of sugar intake between meals and soft drink consumption.Funding
None. 相似文献2.
Background
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) supports the hospitalisation of Palestine refugees with country-specific policies in five fields of operation; Jordan, Lebanon, Syria, Gaza, and the West Bank. The objective of this study was to compare caseloads and percentage vulnerability generated by the different policies.Methods
A comparative snapshot analysis was conducted on diagnoses for hospitalized patients (13?818 patients in total) for selected months in 2016 and 2017, categorized according to UNRWA-defined criteria (lifesaving, urgent, or non-urgent surgeries, and vaginal delivery or caesarian section). The vulnerability criterion was the Social Safety Net Program (SSNP) status of Palestine refugees (enrolment in the UNRWA SSNP). Data were processed in Excel. Ethical approval was granted from the UNRWA Department of Health.Findings
In Jordan, 85% of support (1905 of 2242 cases) was provided for deliveries (vaginal delivery or caesarian section). In Lebanon, 66% (2662 of 4064) were lifesaving and urgent interventions, 26% (1051) non-urgent surgeries, and 7% (284) deliveries. In Syria, 40% (637 of 1594) were urgent, 38% (605) non-urgent surgeries, and 19% (303) deliveries. In Gaza, 26% (675 of 2657) were urgent, 35% (924) non-urgent surgeries, and 40% (1058) deliveries. In the West Bank, 43% (1412 of 3261) were urgent, 10% (333) non-urgent surgeries, and 42% (1367) deliveries. The percentage of vulnerable cases reflects the safety net role of UNRWA: 16% (351) in Jordan, 20% (817) in Lebanon, 46% (738) in Syria, and 19% (506) in Gaza. In the West Bank, only 3% (106) of patients were vulnerable.Interpretation
The profile of patients that used the UNRWA hospitalisation support programme is consistent with hospitalisation policies in UNRWA's fields of operation and the different access that Palestine refugees have to local health services. There is reasonable health-care provision for Palestine refugees in Jordan, whereas UNRWA is the only health-care provider for most Palestine refugees in Lebanon. Ongoing conflict limits access to health care in Syria. Mixed caseloads reflect that priority is given to surgeries and deliveries in Gaza and that UNRWA is the alternative to Ministry of Health services in the West Bank, as the mixed UNRWA caseloads in the West Bank match those of government-supported hospitalisation services, suggesting that people use either one or another. In the case of Gaza, UNRWA-supported hospitals focus on those services most requested by potential users, non-urgent surgeries and deliveries, which become complementary to government services. UNRWA should improve its data collection to have more accurate and up-to-date data. More analysis is needed to understand the financial implications of the differences in policies and how to perform strategic interventions.Funding
None. 相似文献3.
Nisreen Salti Jad Chaaban Hala Ghattas Alexandra Irani Karin Seyfert Tala Ismail Salma Khedr 《Lancet》2019
Background
Palestinians in Lebanon have been protracted refugees for 70 years, but the Syrian crisis has caused shocks that threaten to destabilise their already fragile livelihoods. Over a million Syrian refugees and 42?000 Palestinian refugees from Syria have fled to Lebanon, adding pressure to an already weak infrastructure and labour market. The United Nations Relief and Works Agency (UNRWA), the main provider of health, education and relief services to Palestinian refugees, is exceptionally strained. This study examines changes in education, health, employment, food security, and poverty indicators for Palestinian refugees in Lebanon (excluding Palestinian refugees from Syria) using two nationally representative household surveys conducted in April, 2010, and July, 2015.Methods
The surveys were conducted using multi-stage cluster random sampling. Both surveys included households residing in camps and gatherings. Health conditions were reported for all household members by a proxy survey respondent from among the household members. Food insecurity was assessed using the Arab Family Food Security Scale. The poverty lines (thresholds) were set at US$6·84 per person per day (upper poverty line) and US$2·47 per person per day (extreme poverty line) in 2015, and US$6 per person per day (upper poverty line) and US$2·17 per person per day (extreme poverty line) in 2010. The difference across the 2 years reflects adjustment for inflation rates within the 5-year period. Data were analysed using STATA13. The study was approved by the Institutional Review Board of the American University of Beirut. Informed verbal consent was obtained from the survey respondents.Findings
Of the eligible sampled households of Palestinian refugees in Lebanon, 88% (2974 of 3382) in 2015 and 99% (2593 of 2626) in 2010 gave informed consent and completed the questionnaire. Net enrolment rates for elementary education remained high (98% in 2015 and 95% in 2010), but failed to lead to better labour market outcomes. The unemployment rate increased from 8% in 2010 to 23% in 2015, and the fraction working in elementary occupations increased from 23% to 36%. Overall poverty remained unchanged but with considerable regional shifts: poverty increased by 9% and 11% in central Lebanon and north Lebanon, respectively, whereas it dropped by 8% and 9% in Saida and Tyre. Extreme poverty was halved from 7% to 3%. There was a high prevalence of chronic diseases in both years (37% in 2015 and 31% in 2010); and in 2015, out-of-pocket health expenditure was six times higher when the household reported at least one chronic condition (US$50·9 per capita per month compared with US$8·3 per capita per month). Despite the reduction in extreme poverty, 4% of households shifted from moderate to severe food insecurity.Interpretation
Pressures on UNRWA services come at a time when the organisation is operating with a large shortfall in funding. Recent US funding cuts may have dire repercussions for a population burdened by a high prevalence of chronic conditions and facing high healthcare costs. With additional budgetary strains and worsening labour market conditions, Palestinian refugees in Lebanon risk losing some of the ground that they have gained in net enrolment rates in education, access to health-care services and the reduction in extreme poverty that the UNRWA has worked towards for decades.Funding
UNRWA funded the data collection for both surveys. 相似文献4.
Background
Metabolic syndrome is characterised by the presence of several metabolic abnormalities, including hyperglycaemia, central obesity (also known as abdominal obesity), elevated blood pressure, and an abnormal blood lipid profile. The prevalence of metabolic syndrome is rising rapidly around the world as childhood obesity is increasing. The aim of this study is to determine the prevalence of metabolic syndrome in school children aged 6–18 years residing in Ein Alhelwe Refugee camp in Saida, Lebanon.Methods
School children aged 6–18 years from the first to twelfth grades from two United Nations Relief and Works Agency (UNRWA) schools were randomly chosen. We used a school-based cross-sectional study design with two stages. The first stage included measurements of weight, height, body mass index (BMI), waist circumference, and blood pressure. In the second stage, blood tests were carried out for fasting blood sugar, triglycerides, and high-density lipoprotein (HDL). Approval was obtained from the ethics committee at Al Hamshari Hospital in Saida, Lebanon. Written permission was obtained from the UNRWA and the principals of the two schools for the first stage, and informed written consent was obtained from parents on behalf of the children involved in the second stage of the study.Findings
The first stage of the research included 487 participants (258 female, 229 male) and the second stage included 73 participants (36 overweight participants [12 male, 24 female] and 37 obese participants [19 male, 18 female]). The prevalence of overweight and obesity were 15·2% (74 of 487) and 14·4% (70 of 487) among all age groups, respectively. Among Palestinian refugee school children in Saida aged 10–18 years, the prevalence of metabolic syndrome was more pronounced when the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) definition was used (30·9%; 21 of 68) compared to the International Diabetes Federation (IDF) definition (11·8%; eight of 68), with no statistical differences between male and female participants. Note that the IDF definition can be applied to children aged 10–18 years, of whom there were 68 participants, and for comparison between IDF and NCEP ATP-III, prevalence of metabolic syndrome was calculated for participants in this age range. Low HDL cholesterol (52·1%; 38 of 73), central obesity (46·6%; 34 of 73), and raised blood pressure (42·5%; 31 of 73) were the leading three common metabolic abnormalities among children who were overweight or obese.Interpretation
This study has shown that metabolic syndrome is common among children who are obese or overweight, who are aged 10–18 years, living in Ein Al-Helwa Refugee Camp in Saida, Lebanon. These data raise the importance of early prevention and treatment of metabolic syndrome and its components (abdominal obesity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated blood glucose) to reduce the risk of diabetes and cardiovascular complications in susceptible individuals. A potential limitation of this study is that the small sample size may not accurately reflect the prevalence of metabolic syndrome.Funding
Palestinian Civil Society Organizations Commission, Life Hope Center, and Palestinian Red Crescent Society Al Hamshari Hospital. 相似文献5.
Kumiko Takai Yasuhiko Kamiya Majed Hababeh Ali Khader Akiko Kitamura Wafaa Zeidan Akihiro Seita 《Lancet》2019
Background
WHO and UNICEF recommend early initiation of breastfeeding, within the first hour after delivery, and exclusive breastfeeding (EBF) in the first 6 months of infant life. The most recent data available (from 2001) show that the EBF prevalence among Palestinian refugee infants under 4 months in Jordan was 24%. The study objectives were to estimate the current prevalence of EBF and early initiation, and to examine factors associated with EBF among refugees from Palestine in Jordan registered with UNRWA.Methods
A cross-sectional facility-based study was conducted between April and June, 2017, in all areas of operation of UNRWA in Jordan; North Amman, South Amman, Irbid, and Zarqa. The study targeted Palestinian refugee mothers of children under 6 months of age surveyed at five UNRWA health centres. One health centre was randomly selected from each area (but two from Zarqa) with proportionate probability, excluding those for which there were problems of accessibility. All eligible mothers who attended maternal and child health services on the day of the survey and agreed to participate were recruited, and the process repeated until the required number of participants was achieved. A structured questionnaire was used to collect data. We used the WHO definition of EBF to measure the proportion of infants under 6 months of age that were breastfed exclusively in the previous 24 hours. Bivariate and multivariate logistic regression analysis were employed to identify the independent predictors of EBF. The study protocol was approved by UNRWA and Nagasaki University. Informed written consent was obtained from each participant prior to the interview.Findings
A total of 307 participants (mean age, 27·4 years; range 17–45) were included in the analysis. Nearly one third (31%; 95 out of 307) lived in a refugee camp. The prevalence of EBF in infants under 6 months was 34% (105 out of 307; 95% CI 29–40), and 49% (148 out of 307; 95% CI 43–54) of mothers started breastfeeding within 1 hour after delivery. The rate of EBF was significantly higher in younger infants. Multiparous mothers (adjusted odds ratio 2·38; 95% CI 1·23–4·59) and mothers who did not have problems with breastfeeding (2·12; 95% CI, 1·25–3·57) were more likely to breastfeed exclusively.Interpretation
The prevalence of EBF has improved since 2001, but is still below the WHO recommendation of 50%. Providing adequate support, especially to first-time mothers, mothers who have problems (eg, difficulty in latching on and mastitis), and mothers of older infants, may be a feasible strategy to improve the prevalence of EBF among refugees from Palestine in Jordan.Funding
Jointly funded by Nagasaki University and UNRWA. 相似文献6.
Background
Diabetes is of growing concern, as the global prevalence of this disease in adults over 18 years of age has risen from 4·7% in 1980 to 8·5% in 2014. Type 2 diabetes makes up approximately 90% of global diabetes cases and is largely the result of unhealthy lifestyle. The aim of this study was to assess the risk factors for developing diabetes in the Palestinian population residing in Lebanon, with the intention of helping to prevent diabetes in this population.Methods
A cross-sectional study was conducted in 18 UNRWA centres randomly selected from across Lebanon between April and May, 2016, involving 1162 people aged 18–74 years (all eligible people in this age range who attended the health centres and agreed to be enrolled in this survey). A questionnaire based on a modified version of the Canadian Diabetes Risk Survey was used to collect and score information about BMI, waist circumference, age, gender, physical activity, fruit and vegetable intake, level of education, and family history of diabetes. Informed verbal consent was obtained from all participants.Findings
Of the Palestine refugees in Lebanon aged 18–74 years, 25·8% (299 of 1162) were at risk of diabetes. For these individuals, the risk factors were obesity or being overweight (68·4%), large waist circumference (>92 cm for males >80 cm for females; 62·3%), low physical activity (eg, walking for less than 30 minutes per day; 49·9%), low fruit and vegetable intake (46·0% ate fruits and vegetables every day), and family history of diabetes (68·5%). These risk factor levels have been associated with high risk of developing diabetes within 10 years in other populations. In our sample population, the risk of developing diabetes is higher with age (60·6% for people aged 45 years or over vs 3·1% for people under 45 years), male sex (36·9% risk vs 26% for females), and lower level of education (31·2% for people with preparatory and secondary level of education (school grades 1 to 9) vs 12·7% for people with a high school (school grades 10 to 12; pre-university) or university degree.Interpretation
Risk factors for developing diabetes are widely present among Palestine refugees in Lebanon, leading to a relatively high risk of developing diabetes (for example, compared to Canada). Awareness campaigns and educational sessions should be conducted at community level. Topics will include simple lifestyle modifications that have been shown to be effective in preventing or delaying the onset of type 2 diabetes and its complications.Funding
None. 相似文献7.
Background
Obesity is a global public health issue and worldwide rates of childhood obesity are ten times higher than 40 years ago. A limited number of studies have been conducted to determine the prevalence of preschool obesity and overweight and associated factors in Palestinian children. The aim of this study was to examine sociodemographic and economic factors associated with preschool overweight and obesity in Palestinian children younger than 5 years of age.Methods
We used data from the fifth Palestinian Multiple Indicator Cluster Survey (MICS5), a cross-sectional survey of a representative sample of Palestinian households in 2014. The analysis was based on 6853 children (after excluding children whose z-score was out of range or not measured) below 5 years of age (46% [3152 out of 6853] in the Gaza Strip and 54% [3701 out of 6853] in the West Bank), drawn from 7816 completed surveys of a multi-stage cluster sample (99% response rate). The z-scores for BMI-for-age of children were used to evaluate weight status. Underweight, overweight, and obesity were defined as the proportion of preschool children with z-score values of 2 SDs or less, greater than 2 SDs, and greater than 3 SDs, respectively, from the WHO Child Growth Standards. Covariates included gender, age, area and region, number of children per household, mother's level of education, marital status of the mother, mother's age at birth, and wealth quantile (which we used as a composite indicator of wealth, with the first quintile representing the poorest households, and the fifth quintile representing the wealthiest households). We used multiple logistic regression analysis to estimate adjusted odds ratios (AORs) with 95% confidence intervals (CIs).Findings
The overall prevalence of overweight and obesity in Palestinian children (birth to 5 years) was 8·8% (95% CI 8·1–9·4); 7·3% were overweight and 1·5% were obese. The prevalence of underweight was 1·4%. The odds of overweight and obesity were lower among children in the Gaza Strip than in the West Bank (AOR=0·74; 95% CI 0·61–0·90). Girls were less likely to be obese and overweight than boys (AOR=0·75; 95% CI 0·63–0·89). Children under 4 years of age had a higher risk of being obese and overweight than children aged 4–5 years. Children who lived in the wealthiest households (fifth quintile) were more likely to be overweight and obese than children in the poorest (first) quintile (AOR=1·36; 95% CI 1·09–1·71).Interpretation
The prevalence of obesity and overweight among preschool children in Palestine (8·8%) is higher than the global prevalence (6·7%; derived using the same standardised method as in this study, and using the WHO Child Growth Standards to assess the nutritional status of children). Obesity and overweight were more likely to affect children from wealthier households, children from the West Bank, boys, and younger children. Excessive weight gain in early childhood is a strong predictor of adulthood obesity. Routine assessment of all children needs to become standard clinical practice from very early childhood. Effective management and preventive interventions are needed to tackle the increasing obesity problem in preschool children.Funding
None. 相似文献8.
Background
Access to unsafe water is a concern in the Gaza Strip, where water supplies continue to degrade owing to regional sanctions, bombardment, and mismanagement. Our previous study found that decreased access to public water networks was associated with increased diarrhoea prevalence in children younger than 5 years in the Gaza Strip. This study examined the role of socioeconomic status as an effect modifier in this association.Methods
We used data from five consecutive demographic health surveys and multiple indicator cluster surveys conducted by the Palestinian Central Bureau of Statistics in 2000, 2004, 2006/2007 (December, 2006, to March, 2007), 2010, and 2014. Multivariable logistic regression models were applied to pooled data with prevalence of diarrhoea as the outcome and access to water as the main exposure of interest, with adjustment for age, sex, governorate, and survey year (to adjust for the seasons or other administrative conditions, for each survey). Access to water was characterised by the type of source, namely piped, other improved (eg, public standpipe, borehole, protected dug well, protected spring, and rainwater collection), or unimproved, as defined by the WHO. We defined socioeconomic status in the analysis using maternal education, refugee status, and locality type (urban, rural, or camp).Findings
The odds ratio (OR) of diarrhoea for children with access to unimproved water sources was higher than for those with access to piped water sources when mothers had only primary education (OR 1·35; 95% CI 1·07–1·71) than when mothers also had secondary or higher education (1·09; 0·93–1·27). The OR for children in camps was 1·32 (1·10–1·57) compared with 1·19 in urban areas (1·05–1·36). Point estimates of ORs suggested strong effect modification by refugee status, although with wider CIs for non-registered refugee children (4·95; 1·58–15·55) than for registered refugees (1·35; 1·18–1·53) or non-refugees (1·18; 1·07–1·43).Interpretation
Our results suggest that, in the Gaza strip, children with lower socioeconomic status experience a greater burden of diarrhoea morbidity risk than children with higher socioeconomic status, even when using the same type of water source. Changes to policy are required to address such disproportionate burden of diarrhoea risk in the occupied Palestinian territory.Funding
None. 相似文献9.
10.
Background
There are limited studies about optimal duration and benefits of breastfeeding—and in particular, exclusive breastfeeding—on infant health and growth in the occupied Palestinian territory. This study aimed to evaluate the effect of exclusive breastfeeding on the health of infants in the Gaza Strip (at age 9 months), in terms of anthropometric measurements, growth, and morbidity.Methods
This study targeted mothers with infants attending primary health centres for vaccination at 9 months of age. Eight primary health centres were randomly selected from United Nation for Relief and Work Agency and Ministry of Health primary health centres in four regions of the Gaza Strip. Of 343 mother–infant pairs, in the first 6 months of life 251 infants received mixed feeding and 92 were exclusively breastfed.Findings
There were significant differences between the head circumferences of infants who were exclusively breastfed and those who received mixed feeding (44·1 cm [SD 1·39] and 43·7 cm [SD 1·15], respectively; p=0·007). There were no significant differences in the length and weight of infants between the two groups. Infants who were exclusively breastfed had a significantly lower frequency of gastrointestinal infections than infants who received mixed feeding (48% and 80%, respectively; p=0·001), as well as greater protection against respiratory tract infection (47% and 83%, respectively; p=0·001), lower incidence of otitis media (18% and 38%, respectively), and a significantly lower risk of urinary tract infection (5% and 65% respectively; p=0·001).Interpretation
Human milk is unique, and breastfeeding is the healthiest practice for healthy term infants for approximately the first 6 months after birth, providing ideal nutrition and supporting optimal growth and development. It also provides reasonable protection against infectious diseases. Thus, breastfeeding is the reference model against which all alternative feeding methods must be measured, with respect to growth, and short-term and long-term health outcomes. Infants should be introduced to nutrient-rich, solid foods (with particular attention to iron) at 6 months, with continued breastfeeding for up to 2 years. Every effort should be made to maintain breastfeeding rather than using formula or other milk substitute.Funding
None. 相似文献11.
Background
The Cause of Death Registry data are derived from death notification forms (DNFs). These data are used to formulate mortality statistics that are used in the development of health systems and in public health planning. This study assessed the quality of registered data in DNFs in Gaza to form a basic understanding of the current situation, and with a view to providing evidence-based recommendations to improve data quality.Methods
In 2016, the Ministry of Health issued 4861 DNFs in the Gaza governorate. A representative sample of 509 DNFs was selected using proportional systematic random sampling. A set of indicators was identified using the WHO guidelines for DNF data quality assessment. 13 data items were identified to represent administrative data plus nine items to represent medical data, and a total score for completeness was calculated. The quality of medical data was examined by a doctor trained to analyse the quality of mortality data. Administrative approval was obtained from the Ministry of Health. The assessment did not include any personal data (and all data were anonymous).Findings
The completeness of administrative and medical data was 89·0% (5500 of 6180) and 47·3% (2168 of 4581), respectively. For the underlying cause of death, completeness was 36·5% (186 of 509). The completeness of ICD-10 coding was 46·8% (238 of 509) for the direct cause of death and 12·6% (64 of 509) for the underlying cause. Only 23·0% (three of 13) of DNFs for women of reproductive age indicated whether the woman was pregnant or not and whether her death was related to maternal health problems. The ICD-10 codes with the written cause of death were checked and the ICD-10 documentation was correct in 58·0% (138 out of 238) of DNFs for the direct cause of death and 67·2% (43 out of 64) of DNFs for the underlying cause of death.Interpretation
The completeness and accuracy of medical data in DNFs is low. There is an urgent need to train physicians and medical interns to give the correct death sequence and ICD-10 codes, particularly for the underlying cause of death.Funding
None. 相似文献12.
Background
This exploratory qualitative study investigated self-perceived risk and protection factors that can determine the ability of children living in the Gaza Strip to adjust to a traumatic and risky life context characterised by loss and dispossession.Methods
A cluster sampling procedure was used to represent refugee children from four areas of the Gaza Strip (North Gaza, Gaza, Dheir el-Balat, and Rafah). The sample comprised 200 Palestinian children recruited at primary schools in four refugee camps (Bureij, Gaza Beach Camp, Jabalia, and Rafah Camp) in the Gaza Strip in 2012. Of these children, 104 were boys (mean age 8·6 years [SD 2·3], range 6–11) and 96 girls (9·6 years [2·7], 6–11). The children were engaged in activities aimed at eliciting narratives of military violence and traumatic experiences, and individual, familial, and community-related resources that they had mobilised during the war to cope with traumas. Thematic content analysis was applied to written materials and narratives using Nvivo10 software. The main objective was to identify in detail the dimensions of wellbeing present in the narratives, and perceptions of risk and protective factors. The inter-rater agreement ranged from 74% to 95%.Findings
Both boys (78%; 81 of 104) and girls (52%; 50 of 96) reported having directly experienced traumatic events related to war, episodes of political violence (39% of boys [41 of 104], 38% of girls [36 of 96]), domestic violence (31% of boys [32 of 104], 3% of girls [three of 96]), or community violence (6% of boys [six of 104], 2% of girls [two of 96]). Thematic content analysis led to the identification of ten main themes: relationship with peers, family, and other significant adults, affect balance, constraints on movement, play, health, school, personal satisfaction, and spirituality. In boys, the most severe self-reported risks were related to constraints on movement and affect balance, followed by relationship with family, and health. Play, personal resources, relationship with other significant adults, and school were perceived to be protective factors. The girls reported more sources of protection than risks, conversely, boys perceived themselves to be more at risk than protected.Interpretation
Children deal with ongoing suffering and discomfort by means of subjective and intersubjective agency in multiple domains of their life, showing psychological adaptability.Funding
None. 相似文献13.
Yassir Turki Suha Saleh Shatha Albaik Yasmeen Barham Dorien van de Vrie Yousef Shahin Majed Hababeh Akihiro Seita 《Lancet》2019
Background
Mental health is a major public health priority, particularly among refugees worldwide. The United Nations Relief and Works Agency for Palestine Refugees (UNRWA) started to integrate mental health and psychosocial support (MHPSS) into its primary health-care services in Jordan in late 2017. This baseline study aimed to assess the knowledge, attitudes, practices, and perceived barriers among UNRWA health staff regarding the implementation of the MHPSS programme.Methods
The UNRWA Health Programme conducted a cross-sectional study of a sample of 220 out of the 390 male and female doctors, dentists, nurses, and midwives who work at 16 of the 25 UNRWA health centres in Jordan during November, 2017. Individuals on duty at the health centres on the day of the survey were included. The 16 health centres were selected based on their size and accessibility to surveyors (reflecting proximity to Amman, and the size of population served). Of the selected health centres, seven were large, seven were medium, and two were small according to the UNRWA classification of health centres (based on the number of medical doctors). A validated self-administered questionnaire was used. Ethics approval was granted by the UNRWA Health Programme ethics committee, and informed written consent was obtained from all participants. Data analysis was performed using SPSS (version 22).Findings
Of the participants, 73% (161 of 220) believed that their knowledge of MHPSS programmes was insufficient, with no significant difference (p=0·116) between different categories of staff. Furthermore, 88% (194 of 220) said that they needed more training, 67% (147 of 220) reported that the number of mental health cases is increasing, and 50% (110 of 220) that dealing with these cases is difficult. Reflecting on the past 12 months, 31% of staff (69 out of 220) reported meeting between one and ten children, and 45% (100 out of 220) reported meeting between one and ten adults suspected of having mental illnesses. The most suspected condition was depression (84%; 150 of 220), followed by epilepsy (64%; 140 of 220). The main perceived barriers to implementation included the limited availability of MHPSS policies (87%; 192 of 220), MH professionals (86%; 190 of 220), resources (86%; 189 out of 220), and lack of privacy (14%; 31 out of 220).Interpretation
Most health staff had positive attitudes towards MHPSS programme implementation but felt they lacked the required knowledge. There is a need for training and clear technical guidelines. Perceived barriers to MHPSS programme implementation need to be tackled with a structured plan of action.Funding
The UNRWA Health Programme, UNRWA Headquarters, Amman, Jordan. 相似文献14.
Enas Alaloul Mohamedraed Elshami Esraa Khader Huda Abu Nemer Alaa Alhelu Israa Awad Heba Baraka Bettina Böttcher Khamis Elessi 《Lancet》2019
Background
For patients with breast cancer, the quality of care following mastectomy should be designed with long-term goals to ensure the physical and psychosocial wellbeing of survivors. This study explores the impact of mastectomy on the quality of life of breast cancer survivors in the Gaza Strip.Methods
This cross-sectional study involved the only two oncology centres of the Gaza Strip. In total, 173 patients who had undergone mastectomy were chosen using convenience sampling. Upon their arrival at the oncology centres (a minimum of 3 months after mastectomy), the patients completed face-to-face questionnaires made up of five sections: sociodemographic data, physical, psychological, and social wellbeing, and family dynamics. Data were collected from August, 2015, to September, 2016. SPSS software (version 21) was used for data analysis. Ethics approval was obtained from the Palestinian Ministry of Health.Findings
The mean age at data collection was 51·0 (SD 10·0) years. In total, 73·0% (126 of 173) had low educational achievements (below secondary level), 91·0% (157) were unemployed, and 20·8% (36) had a first-degree relative with breast cancer. Two-thirds (133) had undergone radical mastectomy, and 17·0% (29) had breast-conserving surgery. Evaluation of the negative impacts of mastectomy showed that psychological wellbeing was the most affected domain (66·4%; 115), followed by physical wellbeing (52·2%; 90), social wellbeing (44·2%; 77), and family dynamics (49·2%; 85). Following mastectomy, 57·2% (99), 48·6% (84), and 42·8% (74) of patients experienced fatigue, early menopausal symptoms, and sleep disturbances, respectively. Feeling worried was the most common psychological complaint (52·6%; 91). Furthermore, 55·5% of patients (96) experienced financial impacts (eg, some mentioned that treatment expenses were drawn from very basic living and household funds), and 59·0% (102) had decreased day-to-day activity (physical activity for the household that would usually be carried out on a regular basis, such as chores). Interestingly, 95·4% (165) were worried about divorce owing to their surgery.Interpretation
The fear of divorce found in this study demonstrates the insecurity of women in society in Gaza. However, this study could not validate the reality of such fears (for example, determine the proportion of women who get divorced following mastectomy). Involving the patient's family in the treatment process is important to promote social wellbeing. Improving holistic medical care for survivors of breast cancer in the Gaza Strip is essential.Funding
None. 相似文献15.
Background
Young people in the occupied Palestinian territory are facing considerable challenges that affect their wellbeing. As limited research on youth wellbeing in this region exists, this study aims to assess the prevalence of wellbeing and its determinants among youths in the occupied Palestinian territory.Methods
We carried out a secondary data analysis of the Power2Youth cross-sectional survey, conducted between Oct 13, 2015 and Dec 31, 2015 in the occupied Palestinian territory. The sample consisted of 1353 youths aged 18–29 years (53.8% were female) living in the West Bank and the Gaza Strip. Bivariate and multivariate analyses were conducted with the WHO-5 Well-Being Index as the dependent variable and seven independent variables: demographic (age, sex, locality, and region), socioeconomic status (education and subjective economic situation scale), trust in people, personal freedom, political confidence, satisfaction with the quality of governance, and future outlook. Informed verbal consent was obtained from the participants.Findings
The mean wellbeing score was 58·73 (SD 22·7). Age (β=–0·60, p=0·01) and being male were negatively associated with wellbeing, with male scores approximately three points lower than for females on the wellbeing scale (β=–2·80, p<0·05). By contrast, living in camp areas compared to urban areas (β=4·45, p<0·01), trust in people (β=1·92, p<0·001), personal freedom (β=2·02, p<0·001), satisfaction with the quality of governance (β=2·36, p<0·001), satisfaction with economic conditions (β=1·61, p<0·001) and positive future outlook (β=0·67, p<0·01) were all significantly positively associated with wellbeing.Interpretation
The results underscore the impact of demographic, social, economic, and political circumstances on youth wellbeing in the occupied Palestinian territory, with trust in people, personal freedom, and satisfaction with economic conditions having the greatest impact. These variables and satisfaction with the quality of governance were found to have a significant positive association with youth wellbeing, highlighting the importance of the political domain. Finally, the positive association between outlook and wellbeing indicates that youths' future outlook can impact wellbeing in the present.Funding
The research that produced the Power2Youth dataset received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement number 612782. Analysis and production of the Abstract was supported by Oxfam Quebec. 相似文献16.
17.
Background
Palestinian refugees living in Lebanon continue to face social and economic exclusion that hinders their ability to improve their living conditions and livelihoods. This study aimed to investigate the effect of a two-pronged intervention that employed women through social enterprises to deliver a subsidised healthy daily school meal to elementary schoolchildren in Palestinian camps.Methods
We established two healthy kitchens in community-based organisations in Palestinian camps; these kitchens employed 32 women to provide daily meals to children attending primary schools. We used mixed methods to assess the effect of participating in the intervention on the women's economic, social, and food security outcomes. We also assessed the impact of the subsidised meal programme on children's dietary diversity, nutritional status, school absenteeism, and achievement in two intervention schools, compared to two control schools. Difference-in-difference and regression analyses were conducted to examine the associations between participation and outcomes, controlling for potential confounders. Quantitative and qualitative data analyses were conducted using Stata 13·0 and NVivo 10, respectively. Written informed consent was obtained from women and parents, followed by assent from children prior to participation. All study protocols were approved by the Institutional Review Boards of the American University of Beirut and the University of Maryland.Findings
At baseline, women's median household expenditure was US$169 per capita per month. Additional income due to the intervention was equivalent to US$110 per month, which translated into increases in total household and food expenditures (p=0·040), as well as a reduction in food insecurity (p=0·006). Qualitative data found improvements in morale, social support, and decision making. There were 648 children in the control group, and in the meal programme group there were 260 children with low participation (LP; participated less than 50% of total school days) and 454 with high participation (HP; participated more than 50% of total school days). There was a significantly greater increase in overall diet diversity score (Δ0·32, p=0·0060) and dairy consumption (odds ratio 1·2, 95% CI 1·1–1·3) in the HP group compared to controls. Both LP and HP groups were more likely to consume proteins, and less likely to consume sweetened beverages and desserts than controls. Furthermore, the HP group had a significant increase in haemoglobin (p=0·05) and both LP and HP groups had a significant decrease in school absenteeism (p=0·04) compared with controls.Interpretation
This study provides evidence of the positive effect of the Healthy Kitchens, Healthy Children model on economic, food security, and social outcomes of marginalised women, as well as diet diversity, haemoglobin, and school outcomes of children. This intervention contributed to human capital gains in two generations of protracted refugees.Funding
The Nestle Foundation for the Study of Problems of Nutrition in the World. 相似文献18.
Background
Dental caries is still the most prevalent chronic disease worldwide. In the occupied Palestinian territory, data about oral health status and its determinants are scarce. This study aimed to assess the prevalence of dental caries and associated factors among schoolchildren in a random sample of marginalised schools in the West Bank.Methods
Marginalised schools (according to the School Support Program [SPP] criteria) were stratified by district, gender, and grade level to select a random sample of 20 schools. Students in the sixth and ninth grades were interviewed by senior dental students about their oral hygiene and diet habits. Students' weight, height, gingival health, and dental caries experience were assessed. Senior dental students were trained and calibrated to carry out the interviews and the examinations. Parental informed consents were collected by school administrative staff. Ethics approval for the study was obtained from the Al-Quds University Scientific Research Ethics Committee.Findings
In total, 1282 students completed the interviews and the clinical screening. The mean decayed, missing and filled teeth (DMFT) index was 6·4 (SD 4·4). According to the WHO dental caries experience classification, 49% (309 of 623) of the sixth grade students and 74% (484 of 658) of the ninth grade students fell in the high and very high categories. The mother's level of education and recent visit to the dentist correlated negatively with DMFT score (ρ=–0·06, p=0·029; ρ=–0·063, p=0·024). BMI was correlated positively with DMFT (r=0·092, p=0·001). Drinking milk and fresh juices was related to lower DMFT scores (r=–0·077, p=0·006 and r=–0·072, p=0·010). In the final model, grade (β=0·314, p<0·0001), gender (β=0·058, p=0·034), recent visit to the dentist (β=–0·059, p=0·029) and drinking fresh juices (β=–0·054, p=0·047) were significant factors in explaining the high level of dental caries in this sample.Interpretation
Students in the marginalised schools of the West Bank have high DMFT scores that indicate high prevalence of dental caries. Access to dental care and bad oral health habits are associated with high disease prevalence. Interventions to improve access to care and increase awareness about healthy diet and hygiene habits are crucial to alleviate the burden of oral disease in this population.Funding
AMIDEAST School Support Program (SSP). 相似文献19.
Ron J Smith 《Lancet》2019
Background
The 1990s were dubbed the sanctions decade, typified by the situation in Iraq. The past 10 years have seen continued use of siege, ostensibly in the interest of promoting political change. For this decade, the Gaza Strip has been the model of siege. Siege regimes have also been imposed on Yemen, and to a lesser extent on Qatar, Iran, and areas of Syria. This paper examines the consequences of siege for those in the field of health-care provision, and what responsibilities medical staff have in the face of the human rights crises that accompany siege. Can public health needs be served without an explicit agenda that promotes sovereignty and liberation of populations under siege?Methods
The primary source of data for this paper is secondary literature, popular media and non-governmental organisation (NGO) reports dealing with the effects of siege on health-care provision in Gaza, Yemen, Iraq during the Sanctions period, and Iran. These primary data are supported by participant observation and interviews with medical staff in the Gaza Strip. These data were analysed using a critical political economy framework. Ethics approval was obtained from the Institutional Review Board of Bucknell University.Findings
Siege continues to be promoted as an alternative to warfare in the press and in academic writing. Medical and other NGOs document the strain that blockades represent as they record the extent of health-care crises, but they do not confront the coalitions that impose siege. Discussions of the importance of sovereignty to the promotion of health care remain sidelined within a discourse of wars on terror.Interpretation
Familiarity and engagement with geopolitical practices of isolation and resistance is important for health-care providers in territories under siege. As health-care providers represent front line witnesses of the effects of siege on local populations, their testimonies represent a substantial challenge to the status quo. International and local health workers should coordinate with activists and academics to create a global health paradigm of liberation by promoting local sovereignty and international solidarity.Funding
Bucknell University. 相似文献20.